# EDWARD P FULLER MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588832208
- **Authorized official:** DR. EDWARD P FULLER MD (PRESIDENT)
- **Authorized official phone:** (928) 854-5370

## Contact information

- **Practice address:** 101 CIVIC CENTER LANE, LAKE HAVASU CITY, AZ 86403
- **Practice address phone:** (928) 854-5370
- **Practice address fax:** (928) 854-7942
- **Mailing address:** PO BOX 1189, LAKE HAVASU CITY, AZ 86405
- **Mailing address phone:** (928) 854-5370
- **Mailing address fax:** (928) 854-7942

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | 26880 | AZ | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | C50618 | CA | — |

## Other

- **Enumeration date:** 02/15/2008
- **Last updated:** 02/15/2008